Parenting a kid with OCD
I’m an OCD therapist who has a child with OCD. I’m not a child therapist though, so I was probably more lost than you’d think when one of my kids started exhibiting symptoms.
It started in pre-school with some sensory issues for my child (no I’m not going to tell you which one). The preschool director was “on the fence” about referring them for early evaluation for neurodivergence. But as this kiddo got older, they found more and more flexibility with sensory experiences. “Yay everything is fine,” I thought to myself. Then in kindergarten, there was a lot of inflexible ritual around saying goodbye at the classroom door. It continued into first grade. I started seeing little rituals in their daily behavior, a lot of hyperawareness of bodily sensations and associated health worries, and then some tics. “OH NOOOOOOO…. no way… my kid has OCD?! This is literally my clinical speciality…. why can’t I fix it?”
My tactic (being primarily an adult clinician and not really knowing much about OCD in kids) was to give my kiddo education, nonjudgmental labeling of OCD behaviors, and encouraging flexibility in everyday life. So far, this combination of parent-support behaviors has been enough to keep my child flexible and I think we’ve stopped the progression into full blown OCD, for now. Or perhaps their symptom improvement has absolutely nothing to do with me. Sometimes, kids just grow out of OCD behaviors.
Self compassion - Even the pros get stuck
If I can get stuck with addressing OCD in my own child, anybody can get stuck. I’ve taken hundreds of hours of OCD trainings. As an OCD therapist, I could notice OCD cycles happening and I could provide psychoeducation to my child (probably not at an age-appropriate level) and withdraw accommodations so their OCD didn’t worsen. I knew to do this but was still worried. So I suggest that you start your journey with a TON of self-compassion. Your child having OCD isn't your fault. But also, have hope because there may be things you can learn to do to make it better!
OCD in kids
I treat mostly older adolescents and adults so I don’t have a lot of “street cred” when it comes to treating young kids. My colleagues have told me that treating OCD in kids is largely making evidence-based OCD interventions that work with adults, age-appropriate for children. My personal experience with applying these techniques in my family has shown success so I tend to agree with those child-experts.
In some cases, sudden onset of OCD symptoms in children is associated with syndromes called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). As I understand it (because again…. small kids aren’t my population), a post-infection autoimmune process is responsible for brain changes, in PANDAS/PANS, which results in OCD experiences and behaviors for younger children. There are great resources online to learn about these syndromes. For this reason, I usually provide some resources to parents who see me for support for themselves, so that they ensure their child is up-to-date on check-ups and they’ve discussed their child’s OCD behavior with their pediatrician.
My colleagues assure me that the psychotherapy treatment of PANDAS/PANS-mediated OCD is exactly the same as any other type of OCD, but given the association with (often strep) infections, it’s extra important to make sure the client is under good medical care.
OCD in kids is also more likely to resolve on its own. While I would never advise a family to NOT get treatment for OCD, there are periods of time in a child’s life where they may exhibit OCD symptoms but never progress to full OCD. So while a professional eye on the situation is a great idea, don’t over-rev on this being a disorder. Kids’ minds are amazingly flexible and it might not take them as much treatment (compared to adults) to get better. They also may grow out of it without any treatment (ask a professional before you assume they will but this really does happen).
Treatment must include family
I’m not a family therapist but I’ll tell you as an individual therapist that when a OCD sufferer’s support network isn’t on board with our treatment plan, treatment is SO MUCH MORE DIFFICULT and so slow. Middle-older adults have a bit more executive function and frontal-lobe development and can “power through” OCD treatment independently with more ease than do children, teens, and young adults. Children and teens need a lot more scaffolding through treatment and that scaffolding is in the form of guardian/parent support, reasonable rules that eliminate OCD accommodations, and regular reminding of how OCD works. If a client or family system can possibly afford to have a family therapist (who knows about OCD) help the family while the individual therapist supports the OCD sufferer, treatment will be more effective AND faster.
Examples:
If my OCD kiddo has to say goodbye to me before school in the EXACT same way each day and I can’t do it one day, it makes a big difference for my co-parent to support but not accommodate my kid’s distress when they don’t get the ritual as the OCD demands.
If a child with a tic disorder is working hard to ignore their own tics but their family keeps pointing them out and drawing attention to them, the family will make the child’s suffering worse.
If a child with health anxiety has one parent who allows them to stay home every time they get ramped up about a sensation in their body, they will learn that sick days and avoiding school are a way to help them feel safer and conflict will brew between the permissive parent and the authoritative parent.
Everybody who makes the rules in the child or teen’s life must be on the same page with the best way to manage the OCD to greater flexibility.
Important points
So if you have a kid with OCD, here are my top tips for you:
Develop and nurture your self-compassion. Even the experts struggle with OCD in their own kids. It’s tough to watch your kid suffer and to go against some of your instincts (to soothe and smooth) in order to implement evidence-based OCD therapy techniques. Be gentle.
Make sure your kiddo has a medical workup before assuming that treatment can be all left to a therapist. This is true for adults too but with the possible PANS/PANDAS intersection, it’s doubly important for kids.
Get professional consultation but don’t assume that this diagnosis has to be lifelong or catastrophic. Some kids will grow out of OCD on their own without intervention because their brains are so plastic. So be aware but not overly anxious. Get a consult and try to stay calm.
Consider and prioritize family therapy. This is not “something wrong with your kid,” that a therapist can “fix,” on their own. The whole support system has to be in on the plan and feel supported in setting LOVING limits to scaffold the OCD sufferer. Read the article on accommodations, referenced above. But know that a family therapist is an important part of a good OCD treatment team.